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Am Fam Physician. 2009;79(7):543-544

Obama Seeks Input from AAFP President During White House Health Care Summit

During a March 5, 2009, White House health care summit, American Academy of Family Physicians (AAFP) President Ted Epperly, MD, Boise, Idaho, emphasized to President Obama the need to expand health care coverage to include all Americans, as well as the need to strengthen the primary care workforce. The goal of the summit was to build bipartisan support for a major overhaul of the nation's health care system. More than 120 lawmakers, stakeholders, and citizens were invited to discuss issues surrounding health care reform. Obama stressed to summit participants that he is committed to enacting major health care reform by the end of 2009. He also acknowledged Epperly's concern that the cost of medical education is forcing some students to choose careers in higher-paying specialties, which creates a shortage of primary care physicians. During breakout sessions, Epperly and his group discussed how to reform graduate medical education to produce more primary care physicians, and how to decrease health care costs and improve quality. For more information, visit

Primary Care Physicians Capable of Performing Safe, Effective Colonoscopies

Primary care physicians could help meet the demand for endoscopic screening for colorectal cancer. According to a study in the January/February 2009 issue of the Annals of Family Medicine, colonoscopies performed by primary care physicians have the level of safety and accuracy recommended by gastroenterology professional associations. Although the American College of Gastroenterology has called the study potentially misleading, some primary care physicians argue that the level of experience of the physician matters more than the specialty. Michael Harper, MD, a professor in the Department of Family Medicine and Comprehensive Care, and director of the family medicine residency at Louisiana State University Health Sciences Center, Shreveport, said that increasing endoscopy training in family medicine and internal medicine residencies is the best way to increase the number of physicians who can perform the procedure. Harper, who is also president of the American Association of Primary Care Endoscopists, stressed that patients in medically underserved areas would especially benefit from more primary care physicians performing colonoscopies. For more information, visit or the Annals of Family Medicine Web site at

Budget Proposal Calls for $329 Billion to Block Cuts in Medicare Payment Rates

President Obama has released a $3.6 trillion spending plan for the 2010 fiscal year that would block scheduled reductions in Medicare physician payment rates. The payments cuts, which are based on the sustainable growth rate formula, are scheduled to take place during the next several years. The proposed spending plan would provide $329.6 billion in funding over the next 10 years to block payment cuts, which are predicted to exceed 40 percent during the next seven years. Kevin Burke, director of the AAFP Division of Government Relations, said that because many sources compete for federal funds, it is significant that the president's proposed budget has allocated money specifically for paying physicians. According to Burke, this will make it easier for Congress to find the funds necessary to avoid physician payment cuts. The spending plan also calls for the creation of a reserve fund of $634 billion to cover health care expansion during the next 10 years. To finance health care reform, the proposed budget calls for increasing taxes on the wealthiest Americans, and improving the quality and efficiency of the health care system. For more information, visit

Agencies Receive Funding to Research High-Quality, Cost-Effective Treatments

The Agency for Healthcare Research and Quality, the National Institutes of Health, and the U.S. Department of Health and Human Services (HHS) will be splitting $1.1 billion for comparative effectiveness research. The funding, which is part of the recently enacted American Recovery and Reinvestment Act of 2009, will enable the agencies to conduct head-to-head studies to determine the best medications, devices, and procedures based on cost and overall effectiveness. The legislation also calls for the creation of a Federal Coordinating Council for Comparative Effectiveness to oversee research efforts and encourage coordinated uses of resources. Additionally, the legislation requires the HHS secretary and the Institute of Medicine (IOM) to produce and submit a report to Congress by the end of June 2009 that includes recommendations on research priorities. For more information, visit

Study Shows Physicians Often Override Medication Alerts in EHR Systems

A recent study in the February 9, 2009, issue of Archives of Internal Medicine found that physicians override many medication alerts that are built into electronic health record (EHR) systems to improve patient safety. The study, “Overrides of Medication Alerts in Ambulatory Care,” examined more than 3 million electronic prescriptions from 2,872 clinicians in practices across Massachusetts, New Jersey, and Pennsylvania. Of the 233,537 safety alerts generated from January 1 to September 20, 2006, clinicians accepted only 9.2 percent of drug interaction alerts and 23 percent of allergy alerts. Lead study author Thomas Isaac, MD, MBA, MPH, an internist in the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center in Boston, believes some medication alerts built into EHR systems are not useful to physicians. Isaac hopes the study's findings will help vendors design products with improved prescription alert systems. For more information, visit or the Archives of Internal Medicine Web site at (subscription required).

MEDWATCH: FDA Calls for Boxed Warnings on Metoclopramide Drug Labels

The U.S. Food and Drug Administration (FDA) is now requiring boxed warnings on the labels of metoclopramide, a drug used to treat gastrointestinal disorders. Long-term or high-dose use of metoclopramide has been linked to tardive dyskinesia, which involves involuntary and repetitive movements of the body. The development of tardive dyskinesia is directly related to the length of time the patient takes metoclopramide and the number of doses taken. More than 2 million Americans use metoclopramide-containing products, such as Reglan Tablets, Reglan Oral Disintigrating Tablets, Metoclopramide Oral Solution, and Reglan Injection. For more information, visit

Foundation Raises Awareness of Growing Number of Uninsured Americans

About 46 million Americans, including 9 million children, do not have health insurance, according to statistics from the Robert Wood Johnson Foundation. The foundation hosted the annual Cover the Uninsured Week on March 22–28, 2009, to spotlight the crisis and call on legislators to find solutions. As the economy weakens, more employed persons are at risk of losing coverage. Fewer small businesses are able to offer coverage for employees, and a report from the IOM found that the average amount employees paid per year for family coverage in employer-sponsored plans increased from $1,543 in 1999 to $3,354 in 2008. The report estimates that if this trend continues, the decline in coverage will also continue. For more information, visit

Physicians Hope Cigarette Tax Increase Will Encourage More Patients to Quit

A 62-cent-per-pack federal tax increase on cigarettes that took effect on April 1, 2009, raised the nation's average cost of a pack of cigarettes to $5. According to the Campaign for Tobacco-Free Kids, every 10 percent increase in the price of cigarettes reduces youth smoking by 7 percent and overall consumption by 4 percent. AAFP President Ted Epperly, MD, says physicians should use the combination of increased taxes and the weak economy to talk with patients about quitting. The AAFP's Ask and Act tobacco cessation program encourages physicians to ask all patients about tobacco use, and then act to help those who use tobacco to quit. Evidence has shown that advice from a health care professional can more than double smoking cessation success rates. For more information, visit

Medicare Contractor's Vitamin D Testing Coverage Could Shortchange Patients

The AAFP has called on Medicare provider National Government Services Inc., to review and revise its list of acceptable medical conditions for coverage of vitamin D assay testing. AAFP Board Chair Jim King, MD, of Selmer, Tenn., expressed his dissatisfaction with the Medicare contractor's covered diagnosis codes in a recent letter. King said the draft local coverage determination (LCD) would lead to inadequate care for some patients who need the test. Under the draft LCD, patients with chronic kidney disease, osteomalacia, hypercalcemia, or rickets are covered for vitamin D testing. King has asked the contractor to include osteoporosis, osteopenia, and malabsorption syndromes under the list of accepted conditions for vitamin D testing. For more information, visit


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